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Permit CITY OF TIGARD ELECTRICAL PERMIT C COMMUNITY DEVELOPMENT Permit #: ELC2010 -00603 .T I G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/27/2010 Parcel: 2S 102BA01500 Jurisdiction: Tigard Site address: 12350 SW GRANT AVE Subdivision: Lot: 0 Project: NORTHWEST INVESTMENT HOLDINGS Project Description: (3) branch circuits for corrections to reconnect permit, ELC2010- 00574. Owner: FEES NORTHWEST INVESTMENT HOLDINGS Quantity Description Date Amount P.O. BOX 1152 GIG HARBOR, WA 98335 3 crt Branch Circuits 10/27/2010 $71.02 wo /Purchase Service or PHONE: 503 -789 -7239 Feeder 1 ea 12% State Surcharge - 10/27/2010 $8.52 Electrical Contractor: RUSSELL MAGNUSON 13215 SE MILL PLAIN C -8, #204 VANCOUVER, WA 98684 PHONE: 503 - 888 -6008 FAX: Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $79.54 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in r ance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATT TION: Oregon la r- • ires you to follow the rules adopted by the Oregon Utility Notifica ' • • enter. Those rules are set forth in OAR 952 -001- 10 thr•ugh OAR 952-It r • may obtain a copy of the rules or direct questions to OUNC • - • •9 or 1.800.332.2344. Issue By: `ate ��L_ Permittee Signa �_ �- • • t9Z OWNER INSTALLATION ONLY • The installation is being made on property I own which is not intended for sale, lease or rent. OWNER'S SIGNATURE Date: ONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC' MTN7 Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept In a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. 10/26/2008 06:05 3606948843 FEDEXOFFICE5167 PAGE 01/01 RECEIVED Electrical Permit Application I, () R 014 1( 1 1 `-.1. 0 \ 1 1 City of Tigard OCT 2 7 2 010 y /O 17 /6 Permit Nn.: E',e.0 /o— 603 III 13125 SW Wall Blvd„ Tigard, OR 97223 Plan Review e Phmic: 503,718.2439 Fax: P11 rk TIGARD nay: Other Permit. f4 e Ao/'a — o)„5 - ?y 71 c; n li D inspection Line: 503.639.41 Datc Rmdy/By: Arms: gee Page 2 for Internet; www.tigard-or.go I DIVISION Notifted/Medtottl: 9nppleeknht) Inforrntttten TYPE OF WORK PLAN REVIEW ❑ New construction ❑ Addition/alteration /replacement Please check Within apply (submit 3 sets of plans w /itetm chocked Wow): ❑ Demolition Other ❑ Service or tbedcr 100 amps or morn 0 Building over three ;cerise. where the nvatilable fnoh current D Mminan and boatyards. CATEGORY OIL CONSTRt ICTlON exceeds t o,000 amps at 150 volts or D Floating buildings. 2 dwelling 0 Commercial /industrial less to ground, m once& 14,000 El Commercial -use agricultural 1 - Sind 2 [� Accessory building amps Ibr all other ittenllonoat building,. ❑ Multi- family ❑ Master builder ❑ Other. D Fire pomp. 0 Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION PION °Emergency system. larger separately derived system. © Attrition of new motor load of ❑ "A "E", "1 -2° "I.3 ", lob no.: Job site address: ' ,L3 s o E,' 100HP or more. occupancy. �2L6rJQ 0 She or mote residential units, ❑ Reacstional vehicle paths. City/Sttdc /ZIP: t/ G �, /�y� l� Health-care facilidos 0 Supply voltage for more than i ❑ Hazardaaa locations. 600 volts nomMnl, Suite/bidgJapt no.: 1 Project name: 0 Service or feeder 600 mops or more. FEE SCNEDLT LE Cross street/directions to job site: ne ortaton 1 otr. 1 Fee. i Turd 1 • Pirq-- New residential single. or wniti- tltmily dwelling unit. Includes attached garage. Subdivision' Lot no.: 1,000 sq, R or Ices 16854 1 4 Tax map/parcel no_: Ea. add 500 sq. R or portion 33,92 1 Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. it.) Limited arergy. multifamily I 75.00 2 /it CPheld ( d residential (with above sq. ft) Services or feeders Installatlon and/or relocation 200 amps or Ins 100.70 2 ❑ PROPERTY OWNER /� ' l,4 I ❑ TENANT 201 amps to 400 amps 133.56 2 Name: 10 w.fi iii ,..., iii ,..., r f -- 1h t J°f S ^^" 14./d / � ''j/�' 601 30 2 4 apps to 1 000 mops 301.04 .04 2 Address: R /s i." Over 1,000 amps or volts 552.26 2 .., ,� ., �✓4 ' services or feeders installation, alteration, and City/State/ iP: Ci . / gr• k,Fl- P,( '- i S ._.... relocation Phone: ( ) Fax: ( ) 200 amps or km 59.36 1 Owner inatallatio 71i installbn is being made on property that I own which is not 201 amps to 400 amps 125•06 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Branch dreults - new, alteration, or extension, per panel Owner signature: _ Date: A. Pee for branch circuits with ❑ APPLICANT [ ❑ CONTACT PERSON above service or feeder fee, 7.42 2 each branch circuit Business name: B. Fee for branch circuits without service cm feeder fee. first 56.18 2 Contact name: branch circuit Each mid'1 branch circuit 3., 7.42 2 Address: R Miscellaneous (service or feeder not indntled) Each manufactured or modular City /Statc/ZiP: dwelling service and/or feeder ,11Ut11L,►11A.� 67.84 2 Phone: ( ) Fax :: ( ) Reconnect only 67.84 2 E Pump or irrigation circle 67.84 ^ 2 CONTRACTOR r Sign or outline lighting 67.84 2 Signal eircuit(t) fir Iimited -stagy Business name: /� _tanel, alteration. or extension. Page 2 2 Ss�� f ' in' A h I / Each additional inspection over allowable In any of the above Address: t3 5 f G. � "// 1, / 4't n 0 1 Additional inspection (I hr min) 6625/ hr City/State/ZIP! � invcatigation(1 hr min) 06,25/ v'a' n 1 `C"Q L w Industrial plant (1 hr min) 78.18 /fir Phone: ( 4 ) ; at , (e,0 ; Fax; ) rnapcctions for which no fee is - 7 : specifically listed ('h In min) 90.00/ hr C :' -761 y77 J Electrical Lic. :g • -3 / Shpts. Lie,: 55 ELECTRICAL PERMIT FEFS - y f �, 7 Suprv. Electrician signature, required: Subtotal: Plan review (25% of permit fee): .:5 y Print name: Date: j g State surcharge (12 %of permit fee): Authorized signature: TOTAL PERMIT FEE: 7fd9 permit application expires inn permit is not obtained within 180 Print name: Date: • days aver it has keen Accepted as complete. .....L., • Number of inspections allowed par permit. '